Salvage abdominoperineal resection for squamous cell anal cancer: a 30-year single institution experience

J Hagemans,S Blinde,J Nuyttens,W Morshuis,M Mureau,J Rothbarth,C Verhoef,J Burger

doi:10.1016/j.ejso.2018.10.187

Abstract

Background: If chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) fails, it results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study were to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS).

Highlights

Failure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC
Patients with recurrent anal SCC after salvage abdominoperineal resection (APR) had poor prognosis, irrespective of performance of repeat salvage surgery, which never resulted in cure
The present study describes the results of salvage APR for SCC of the anal canal after failure of initial primary therapy in 47 patients

Summary

Introduction

Failure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study are to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS). All consecutive patients who underwent salvage APR between 1990 and 2016 for histologically confirmed persistent or recurrent anal SCC after failed CRT were retrospectively analyzed. Forty-seven patients underwent salvage APR for either persistent (n = 24) or recurrent SCC (n = 23). Median OS was 47 months [95% confidence interval (CI) 10.0–84.0 months] and 5-year survival was 41.6%, which did not differ significantly between persistent or recurrent disease (p = 0.551). Twenty-one patients developed local recurrence after salvage APR, of whom 8 underwent repeat salvage surgery and 13 received palliative treatment. Median OS was 9 months (95% CI 7.2–10.8 months) after

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